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General NPI Number Information
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NPI Number | 1639364912
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Entity Type | Organization
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Legal Business Name | SOUTH PALM ORTHOSPINE INSTITUTE
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 2900 N MILITARY TRL #241
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City | BOCA RATON
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State | FL
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Zip | 33431-6365
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Country | US
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Telephone | 561-742-5959
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Fax | 561-732-0553
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Provider Business Mailing Address
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Address Line | 6110 W ATLANTIC AVE UNIT A
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City | DELRAY BEACH
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State | FL
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Zip | 33484-8405
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Country | US
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Telephone | 561-742-5959
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Fax | 561-732-0553
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Authorized Official
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Title or Position | OWNER
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Name | STEWART EIDELSON
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Credential | M.D.
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Telephone | 561-742-5959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | ME55593
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License Number State | FL
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